Document Detail


Performance of case definitions used for influenza surveillance among hospitalized patients in a rural area of India.
MedLine Citation:
PMID:  23226892     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess case definitions for influenza in a rural community in India.
METHODS: Residents of the study area who were hospitalized for any acute medical condition for at least one night between May 2009 and April 2011 were enrolled. Respiratory specimens were collected and tested for influenza viruses in a reverse-transcription polymerase chain reaction (PCR). The PCR results were taken as the "gold standard" in evaluating the performance of several case definitions.
FINDINGS: Of the 3179 patients included in the final analysis, 21% (665) were PCR-positive for influenza virus, 96% reported fever and 4% reported shortness of breath. The World Health Organization (WHO) case definition for severe acute respiratory illness had a sensitivity of 11% among patients aged < 5 years and of 3% among older patients. When shortness of breath was excluded from the definition, sensitivities increased (to 69% and 70%, respectively) and corresponding specificities of 43% and 53% were recorded. Among patients aged ≥ 5 years, WHO's definition of a case of influenza-like illness had a sensitivity of 70% and a specificity of 53%. The addition of "cough and reported or measured fever" increased sensitivity to 80% but decreased specificity to 42%.
CONCLUSION: The inclusion of shortness of breath in WHO's case definition for severe acute respiratory illness may grossly underestimate the burden posed by influenza in hospitals. The exclusion of shortness of breath from this definition or, alternatively, the inclusion of "cough and measured or reported fever" may improve estimates of the burden.
Authors:
Siddhivinayak Hirve; Mandeep Chadha; Pallavi Lele; Kathryn E Lafond; Avinash Deoshatwar; Somnath Sambhudas; Sanjay Juvekar; Anthony Mounts; Fatimah Dawood; Renu Lal; Akhilesh Mishra
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2012-10-10
Journal Detail:
Title:  Bulletin of the World Health Organization     Volume:  90     ISSN:  1564-0604     ISO Abbreviation:  Bull. World Health Organ.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-12-10     Completed Date:  2013-11-26     Revised Date:  2013-12-04    
Medline Journal Info:
Nlm Unique ID:  7507052     Medline TA:  Bull World Health Organ     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  804-12     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Comorbidity
Cough / etiology
Dyspnea / etiology
Female
Fever / etiology
Humans
India / epidemiology
Infant
Influenza, Human / complications,  diagnosis*,  epidemiology*,  virology
Inpatients / statistics & numerical data
Male
Middle Aged
Orthomyxoviridae / isolation & purification*
Population Surveillance / methods*
Reverse Transcriptase Polymerase Chain Reaction
Rural Health / statistics & numerical data
Sensitivity and Specificity
Young Adult
Grant Support
ID/Acronym/Agency:
1U01IP000206/IP/NCIRD CDC HHS
Comments/Corrections

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